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Melanie Cole (Host): What kind of medical care would you want if you were too ill or hurt to express your wishes? Advanced directives are legal documents that allow you to spell out your decisions about end of life care ahead of time. They give you a way to tell your wishes to family, friends and health care professionals and to avoid confusion later on. My guest today is Katie Schneider. She is the Aspirus Riverview Hospital and Clinics Patient Relations Coordinator. Welcome to the show Katie. So, what exactly is an advanced directive?

Katie Schneider (Guest): An advanced directive is your wishes regarding future healthcare decisions that you would want if you ever became unable to make those decisions for yourself. So, putting something in writing to let your providers, the people taking care of you know how you would want to be treated if you were ever in a position of not being able to make those decisions known for yourself.

Melanie: Are these for everyone or is it just really for the elderly people that maybe end up in the hospital a lot or somebody who has been diagnosed with cancer; who are they for?

Katie: That’s a great question. They are for everybody that is over the age of 18 who are competent adults capable of completing a document that would let providers know what they would want done in the event that they were not able to speak for themselves. So, Wisconsin is not a next of kin state and what I mean by that is even if you have been married for many years; your spouse is not able to speak for you when it comes to medical decisions, if you are not able to make those for yourself, nor is an adult child and so many times, people don’t realize that we are in a state that does not have a law that allows for the next of kin to make those decisions automatically. So, it is really important to actually have something in writing whereby somebody could legally speak for you in the event you were not able to speak for yourself.

Melanie: Katie, what’s the difference between a living will, an advanced directive and a medical power or healthcare power of attorney?

Katie: That’s also a great question. So, advance directives really kind of covers the broad spectrum of wishes that you put in writing whether it is power of attorney for healthcare or a living will; both are considered to be advanced directives. There are also other documents out there as well. Some people might be familiar with a document called Five Wishes or another document called POLST which is an acronym that stands for physician orders for life sustaining treatment, but the ones that are most commonly used in our area, have been the power of attorney for healthcare and the living will. Living will is sometimes referred to as a declaration to physicians and it is a set of instructions that are signed by a patient telling the doctor what they would want done in very limited situations. So, a living will only covers healthcare decisions when a person is in a persistent vegetative state, kind of like a comatose state or when a person would be terminally ill or death would be imminent. Generally, they consider terminal illness to be a life expectancy of six months or less. So, the living will is pretty limited in its scope where a power of attorney for healthcare allows you to authorize someone else who is considered the agent, to make healthcare decisions for you if you ever become temporarily or permanently unable to make those decisions for yourself. So, there isn’t that stipulation that you have to be in a persistent vegetative state or that it is only activated in a terminal health condition. This would be somebody that is simply not capable of receiving or understanding information in a way to make their own healthcare decisions. This would appoint - activate your agent or somebody that you have previously said you would like to be your spokesperson.

Melanie: Many people might hesitate to do an advanced directive Katie, because they think you have to hire a lawyer. So how does it work to actually get one going?

Katie: Oh, well you don’t have to hire a lawyer, although many attorneys do offer this in the scope of their practice; but they will charge you for that as well, so, actually for those that are computer savvy, you can go to the state of Wisconsin website and find a power of attorney for healthcare. It is a Word fillable document so you can actually type it out online and then print it or we do offer a free workshop here at Aspirus Riverview. It is always the first Wednesday of every month and it starts at 9:30 in the morning and we help people go through the actual power of attorney for healthcare document, answer any questions that they might have and then if they want to complete the document that day, we will help them do that and then serve a witnesses for their document, so they can come to the workshop or they can also pick up free copies of the document at the hospital. We have them located on a bookshelf across from our gift shop and the instructions for completion are attached; very easy to follow. So, for people that are comfortable to kind of do it on their own; they are always welcome to come in and pick up a free copy of the document and take that home with them.

Melanie: So, Katie, now the tough question. How do you pick the person to be whether it is your healthcare power of attorney or the person that you would want to make those medical decisions should you not be able to do that and I mean because that could cause trouble in families if you don’t have an advanced directive, there could be arguments? How do you pick the person? And discuss it. Some people don’t even want to discuss this.

Katie: And that’s the important thing. What I really – whenever I have the workshop for advanced directives here at Aspirus Riverview; I always want people to walk away knowing these two things. Number one; don’t complete the document and make the mistake of not having the conversation with your agent or agents about what you would want done or not done if you were ever unable to speak for yourself because the idea behind the document is not that this person is now making the decision for you; the idea is that you have already decided what you would want done or wouldn’t want done and you have communicated that to your agent who is then your spokesperson. So, that’s the difference, is that you know you pick your agent, somebody that will – that you trust who will certainly adhere to what your wishes are versus impose their own thoughts, beliefs, actions upon what they would want for you. So, that’s very important to pick the right person. Somebody you trust, who is going to act on what your decisions have already been essentially be your spokesperson versus a decision maker and that’s really a gift to the people that care about you to have that in place ahead of time so that they are not the deer in the headlights looking like, “Oh my goodness, what would this person have wanted. We never had the conversation,” and so they are trying to search for what would be the best thing to do. It is far better to have the conversation about what you would want done so that your agent knows this is what they had previously expressed to me.

The other thing that I always want people to understand is that they frequently think when they complete the healthcare power of attorney that it is already in place, that it is active and ready to go. So, we still get people that – once in awhile come into the emergency department and say, “Oh, my adult daughter is my power of attorney, she signs all of my paperwork.” That is not the case, you are still in the driver’s seat with your own healthcare decisions until two physicians – unless or until two physicians or a physician and a clinical psychologist personally examine you and sign a statement that you meet the definition of mental incapacity. So, the document is just kind of waiting in the wings in case it ever needs to be activated. It is not activated the minute that you complete and sign on the dotted line. So, people don’t often understand that there is an activation piece to that document.

So those are the two things I really like people to know. Number one; chose somebody that you trust, make sure you have the conversation so that they know what you would want done and what you wouldn’t want done and then understand that this does not go into effect the day that you sign it; it may never go into effect if you always have decision making capacity, you may never need to use your document. It is just kind of waiting in the wings in case.

Melanie: That is great information. Now what about EMS; if you have an advanced directive, do they honor whatever that is or contact? Do they know about it? Do you keep it on your fridge? And do other states recognize an advanced directive from one state?

Katie: Well, the first question in terms of EMS. EMS is always going to err on the side of doing too much versus too little in an emergent life-threatening situation. The one thing that people can do which is a part of the power of attorney for healthcare packet that we offer here at the hospital; there is some supporting information that is attached from the Coalition of Wisconsin Aging Groups which includes a wallet card. So, if you are in traumatic accident or something happens where you can’t identify who you are to emergency personnel, the first thing they always go for usually is your wallet to find your identification. If they find your wallet and you have completed this wallet card that comes in this packet; it would notify the emergency services providers that you have completed a power of attorney for healthcare and who your agent is and what their phone number is. So, that is something that is available in the kit from the Coalition of Wisconsin Aging Groups which is attached to the healthcare power of attorney. So, they won’t always know that you have created one, but if you have completed the wallet card and you are not able to identify yourself; that might be something that they then discover in your wallet. Again, they would always err on the side of doing too much versus doing too little when it comes to a life-threatening situation.

The second question which is also a very good question because we do have people that oftentimes go south for the winter or might have dual residences and they wonder if I have a state of Wisconsin power of attorney for healthcare would that be honored if I was in Arizona or in Florida and the answer is it’s covered- it would be honored to the extent that it is covered under that state’s law. The same is true for Wisconsin. So, if you have completed a power of attorney for healthcare in Florida or another state and you are in Wisconsin; we would honor that document to the extent that it would be covered under our state law. So, there is some reciprocity there, but sometimes I do advise people that have dual residences to maybe have a document in both states that they reside.

Melanie: And just to summarize and it is such important information, Katie, for people to hear. How do you want them to start that conversation? Give us your best advice about advanced directives and starting that conversation with maybe reluctant family members.

Katie: Well, I think, again, I think it is really a gift to your family to put those decisions in writing and have those things in place hoping that you never have to use them. So, it is very simple to create the document. Sometimes people are very fearful when they look at all the paperwork and they think, “Oh my goodness, I’m never going to be able to understand this. It seems like it is a lot of legal speak.” But when you actually look at the document, it is pretty simple to complete and honestly, you could complete it in about five minutes or less. What’s hard about it is thinking about it and having the conversation. But what I have seen and again the Coalition of Wisconsin Aging Groups really has some nice supporting documentation that goes along with the power of attorney for healthcare packet, where they give you 25 suggested topics to discuss with your healthcare agent because people that don’t work in healthcare don’t always think about the things that may happen to them. Who wants to think about that stuff? But this gives you a starting point where you can sit down and say, “Gosh if my kidneys all of the sudden stop working, is kidney dialysis something that I would consider and under what circumstances?’ And kind of leads you through those conversations. So, it is not a part of the legal document, but it gives you that good starting place to have the conversation and I see people actually take notes on those sheets, just to kind of jog their memory.

The important thing is though is that you revisit the document and you revisit those conversations, because there is a whole lot that can change over the course of sometimes a short period of time with regards to somebody’s healthcare. And what you have decided maybe a year ago or two years ago, now you think very differently about and so it is not one of those things that you can just put away and forget about it. I think you have to have those conversations over again and say, ‘Do I still feel the same way that I did when I completed my document?” And maybe you want to complete a new document if you feel differently. Completing a new document is very simple and like I say, we can complete it in probably less than ten minutes and then any new document would supersede an older document that you would have in writing. But it is important to keep track of where you have given copies of that document so that if you do create a new document, you can make sure that all the places that had the older document now have the more current version.

Melanie: Thank you so much Katie, for being with us today. This is Aspirus Health Talk with Aspirus Health System. And for more information, you can go to www.aspirus.org . That’s www.aspirus.org. This is Melanie Cole. Thanks so much for listening,